NUR 354 Exam 4 Comprehensive Review |
Full Questions, Correct Answers and
Rationales | | 2026/2027 Updated | Arizona
College of Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
145 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
Comprehensive proctored exam covering high-acuity medical-surgical management, maternal-newborn
complications, pediatric milestones and safety, mental health crisis intervention, and prioritization/delegation
principles. Items emphasize clinical judgment, evidence-based practice, and safe decision-making consistent
with NCLEX-RN and AACN Essentials.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 76% (38/50).
HIGHP - Page 1 of 47
,1. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates a therapeutic response to the medication?
[ ] A. Urine output of 60 mL/hr with decreased bilateral crackles
[ ] B. Serum potassium of 3.1 mEq/L with muscle weakness
[ ] C. Weight loss of 0.5 kg over 24 hours with dry mucous membranes
[ ] D. Blood pressure 92/58 mm Hg with dizziness on standing
CORRECT: A. Urine output of 60 mL/hr with decreased bilateral crackles
Loop diuretics like furosemide promote diuresis and reduce pulmonary congestion, so increased urine output
with clearing crackles indicates therapeutic effect. Hypokalemia (B) is an adverse effect, not a therapeutic
response. Minimal weight loss with dehydration signs (C) suggests overdiuresis or inadequate dosing.
Hypotension (D) reflects a complication, not the intended therapeutic outcome.
2. A nurse is preparing to administer oxytocin to a patient in active labor. Which
assessment finding should prompt the nurse to withhold the medication and notify the
provider?
[ ] A. Contractions lasting 45 seconds with 3-minute intervals
[ ] B. Fetal heart rate baseline of 145 beats/min with moderate variability
[ ] C. Late decelerations with a fetal heart rate of 100 beats/min
[ ] D. Cervical dilation of 6 cm with 80% effacement
CORRECT: C. Late decelerations with a fetal heart rate of 100 beats/min
Late decelerations with fetal bradycardia indicate uteroplacental insufficiency and fetal intolerance of labor;
oxytocin must be stopped immediately. Normal contraction patterns (A), a reassuring fetal heart rate (B), and
expected labor progress (C) do not contraindicate oxytocin administration.
3. A child with acute lymphoblastic leukemia is admitted for chemotherapy. Which
laboratory value requires the most immediate intervention?
[ ] A. Hemoglobin 9.2 g/dL
[ ] B. Platelet count 18,000/mm³
[ ] C. White blood cell count 3,200/mm³
[ ] D. Absolute neutrophil count 1,200/mm³
CORRECT: B. Platelet count 18,000/mm³
A platelet count below 20,000/mm³ places the child at high risk for spontaneous bleeding, including
intracranial hemorrhage, and requires immediate platelet transfusion. Mild anemia (A) and leukopenia (C) are
expected with chemotherapy but less urgent. An ANC of 1,200 (D) indicates moderate neutropenia but does
not require immediate transfusion.
HIGHP - Page 2 of 47
,4. A patient with schizophrenia is experiencing acute agitation and is prescribed
haloperidol. Which adverse effect should the nurse monitor for most closely in the first 24
hours?
[ ] A. Weight gain and hyperglycemia
[ ] B. Acute dystonia and muscle rigidity
[ ] C. Sedation and orthostatic hypotension
[ ] D. Dry mouth and constipation
CORRECT: B. Acute dystonia and muscle rigidity
Haloperidol, a high-potency typical antipsychotic, commonly causes acute extrapyramidal symptoms such as
dystonia and rigidity within hours of administration. Metabolic effects (A) are more associated with atypical
antipsychotics. Sedation and hypotension (C) are less prominent with high-potency agents. Anticholinergic
effects (D) are mild compared to the risk of acute dystonia.
5. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
[ ] A. Assessing a postoperative patient's incisional pain
[ ] B. Administering a PRN oral analgesic
[ ] C. Measuring and recording a patient's intake and output
[ ] D. Teaching a patient about a new prescription for warfarin
CORRECT: C. Measuring and recording a patient's intake and output
Measuring and recording intake and output is a routine, non-invasive task within UAP scope. Assessment
(A), medication administration (B), and patient teaching (D) require the clinical judgment and licensure of a
registered nurse and cannot be delegated.
6. A patient with type 1 diabetes is admitted with diabetic ketoacidosis. Which finding
should the nurse expect on the initial laboratory results?
[ ] A. pH 7.48, HCO3 30 mEq/L, glucose 600 mg/dL
[ ] B. pH 7.25, HCO3 12 mEq/L, glucose 480 mg/dL
[ ] C. pH 7.38, HCO3 24 mEq/L, glucose 250 mg/dL
[ ] D. pH 7.30, HCO3 20 mEq/L, glucose 180 mg/dL
CORRECT: B. pH 7.25, HCO3 12 mEq/L, glucose 480 mg/dL
DKA is characterized by metabolic acidosis (low pH, low bicarbonate) with hyperglycemia and ketonemia.
Option B reflects this classic pattern. Option A shows metabolic alkalosis, not DKA. Options C and D show
normal or near-normal values inconsistent with DKA.
HIGHP - Page 3 of 47
, 7. A patient receiving a blood transfusion develops fever, chills, and flank pain 15 minutes
into the infusion. Which action should the nurse take first?
[ ] A. Administer acetaminophen as prescribed
[ ] B. Stop the transfusion and maintain IV access with normal saline
[ ] C. Slow the transfusion rate and reassess in 15 minutes
[ ] D. Obtain a urine specimen for hemoglobinuria
CORRECT: B. Stop the transfusion and maintain IV access with normal saline
These signs suggest an acute hemolytic transfusion reaction, which requires immediate cessation of the
transfusion and maintenance of IV access with normal saline to support renal perfusion. Administering
acetaminophen (A) or slowing the rate (C) delays essential treatment. Obtaining a urine specimen (D) is
important but not the first action.
8. A nurse is caring for a patient with a new colostomy. Which statement by the patient
indicates correct understanding of stoma care?
[ ] A. I will clean the stoma with alcohol before applying the pouch.
[ ] B. I should expect the stoma to be pale and dry.
[ ] C. I will measure the stoma each time I change the pouch.
[ ] D. I will apply the pouch when the stoma is inactive.
CORRECT: C. I will measure the stoma each time I change the pouch.
The stoma shrinks over the first 6-8 weeks, so measuring it before each pouch change ensures a proper fit
and prevents leakage. Alcohol (A) is irritating and should be avoided. A healthy stoma is pink and moist (B),
not pale and dry. The pouch should be applied when the stoma is active (D) to avoid output interfering with
the seal.
9. A patient with major depressive disorder is started on sertraline. Which teaching point
is most important for the nurse to include?
[ ] A. The full therapeutic effect may take 4 to 6 weeks.
[ ] B. The medication should be taken at bedtime to prevent insomnia.
[ ] C. Tyramine-rich foods must be avoided.
[ ] D. Blood levels must be monitored weekly.
CORRECT: A. The full therapeutic effect may take 4 to 6 weeks.
SSRIs like sertraline require 4-6 weeks for full therapeutic effect, and patients should be informed to prevent
premature discontinuation. Sertraline is typically taken in the morning due to potential insomnia (B). Tyramine
restrictions (C) apply to MAOIs, not SSRIs. Routine blood level monitoring (D) is not required for sertraline.
HIGHP - Page 4 of 47
Full Questions, Correct Answers and
Rationales | | 2026/2027 Updated | Arizona
College of Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
145 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
Comprehensive proctored exam covering high-acuity medical-surgical management, maternal-newborn
complications, pediatric milestones and safety, mental health crisis intervention, and prioritization/delegation
principles. Items emphasize clinical judgment, evidence-based practice, and safe decision-making consistent
with NCLEX-RN and AACN Essentials.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 76% (38/50).
HIGHP - Page 1 of 47
,1. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates a therapeutic response to the medication?
[ ] A. Urine output of 60 mL/hr with decreased bilateral crackles
[ ] B. Serum potassium of 3.1 mEq/L with muscle weakness
[ ] C. Weight loss of 0.5 kg over 24 hours with dry mucous membranes
[ ] D. Blood pressure 92/58 mm Hg with dizziness on standing
CORRECT: A. Urine output of 60 mL/hr with decreased bilateral crackles
Loop diuretics like furosemide promote diuresis and reduce pulmonary congestion, so increased urine output
with clearing crackles indicates therapeutic effect. Hypokalemia (B) is an adverse effect, not a therapeutic
response. Minimal weight loss with dehydration signs (C) suggests overdiuresis or inadequate dosing.
Hypotension (D) reflects a complication, not the intended therapeutic outcome.
2. A nurse is preparing to administer oxytocin to a patient in active labor. Which
assessment finding should prompt the nurse to withhold the medication and notify the
provider?
[ ] A. Contractions lasting 45 seconds with 3-minute intervals
[ ] B. Fetal heart rate baseline of 145 beats/min with moderate variability
[ ] C. Late decelerations with a fetal heart rate of 100 beats/min
[ ] D. Cervical dilation of 6 cm with 80% effacement
CORRECT: C. Late decelerations with a fetal heart rate of 100 beats/min
Late decelerations with fetal bradycardia indicate uteroplacental insufficiency and fetal intolerance of labor;
oxytocin must be stopped immediately. Normal contraction patterns (A), a reassuring fetal heart rate (B), and
expected labor progress (C) do not contraindicate oxytocin administration.
3. A child with acute lymphoblastic leukemia is admitted for chemotherapy. Which
laboratory value requires the most immediate intervention?
[ ] A. Hemoglobin 9.2 g/dL
[ ] B. Platelet count 18,000/mm³
[ ] C. White blood cell count 3,200/mm³
[ ] D. Absolute neutrophil count 1,200/mm³
CORRECT: B. Platelet count 18,000/mm³
A platelet count below 20,000/mm³ places the child at high risk for spontaneous bleeding, including
intracranial hemorrhage, and requires immediate platelet transfusion. Mild anemia (A) and leukopenia (C) are
expected with chemotherapy but less urgent. An ANC of 1,200 (D) indicates moderate neutropenia but does
not require immediate transfusion.
HIGHP - Page 2 of 47
,4. A patient with schizophrenia is experiencing acute agitation and is prescribed
haloperidol. Which adverse effect should the nurse monitor for most closely in the first 24
hours?
[ ] A. Weight gain and hyperglycemia
[ ] B. Acute dystonia and muscle rigidity
[ ] C. Sedation and orthostatic hypotension
[ ] D. Dry mouth and constipation
CORRECT: B. Acute dystonia and muscle rigidity
Haloperidol, a high-potency typical antipsychotic, commonly causes acute extrapyramidal symptoms such as
dystonia and rigidity within hours of administration. Metabolic effects (A) are more associated with atypical
antipsychotics. Sedation and hypotension (C) are less prominent with high-potency agents. Anticholinergic
effects (D) are mild compared to the risk of acute dystonia.
5. A nurse is delegating tasks to unlicensed assistive personnel (UAP). Which task is most
appropriate to delegate?
[ ] A. Assessing a postoperative patient's incisional pain
[ ] B. Administering a PRN oral analgesic
[ ] C. Measuring and recording a patient's intake and output
[ ] D. Teaching a patient about a new prescription for warfarin
CORRECT: C. Measuring and recording a patient's intake and output
Measuring and recording intake and output is a routine, non-invasive task within UAP scope. Assessment
(A), medication administration (B), and patient teaching (D) require the clinical judgment and licensure of a
registered nurse and cannot be delegated.
6. A patient with type 1 diabetes is admitted with diabetic ketoacidosis. Which finding
should the nurse expect on the initial laboratory results?
[ ] A. pH 7.48, HCO3 30 mEq/L, glucose 600 mg/dL
[ ] B. pH 7.25, HCO3 12 mEq/L, glucose 480 mg/dL
[ ] C. pH 7.38, HCO3 24 mEq/L, glucose 250 mg/dL
[ ] D. pH 7.30, HCO3 20 mEq/L, glucose 180 mg/dL
CORRECT: B. pH 7.25, HCO3 12 mEq/L, glucose 480 mg/dL
DKA is characterized by metabolic acidosis (low pH, low bicarbonate) with hyperglycemia and ketonemia.
Option B reflects this classic pattern. Option A shows metabolic alkalosis, not DKA. Options C and D show
normal or near-normal values inconsistent with DKA.
HIGHP - Page 3 of 47
, 7. A patient receiving a blood transfusion develops fever, chills, and flank pain 15 minutes
into the infusion. Which action should the nurse take first?
[ ] A. Administer acetaminophen as prescribed
[ ] B. Stop the transfusion and maintain IV access with normal saline
[ ] C. Slow the transfusion rate and reassess in 15 minutes
[ ] D. Obtain a urine specimen for hemoglobinuria
CORRECT: B. Stop the transfusion and maintain IV access with normal saline
These signs suggest an acute hemolytic transfusion reaction, which requires immediate cessation of the
transfusion and maintenance of IV access with normal saline to support renal perfusion. Administering
acetaminophen (A) or slowing the rate (C) delays essential treatment. Obtaining a urine specimen (D) is
important but not the first action.
8. A nurse is caring for a patient with a new colostomy. Which statement by the patient
indicates correct understanding of stoma care?
[ ] A. I will clean the stoma with alcohol before applying the pouch.
[ ] B. I should expect the stoma to be pale and dry.
[ ] C. I will measure the stoma each time I change the pouch.
[ ] D. I will apply the pouch when the stoma is inactive.
CORRECT: C. I will measure the stoma each time I change the pouch.
The stoma shrinks over the first 6-8 weeks, so measuring it before each pouch change ensures a proper fit
and prevents leakage. Alcohol (A) is irritating and should be avoided. A healthy stoma is pink and moist (B),
not pale and dry. The pouch should be applied when the stoma is active (D) to avoid output interfering with
the seal.
9. A patient with major depressive disorder is started on sertraline. Which teaching point
is most important for the nurse to include?
[ ] A. The full therapeutic effect may take 4 to 6 weeks.
[ ] B. The medication should be taken at bedtime to prevent insomnia.
[ ] C. Tyramine-rich foods must be avoided.
[ ] D. Blood levels must be monitored weekly.
CORRECT: A. The full therapeutic effect may take 4 to 6 weeks.
SSRIs like sertraline require 4-6 weeks for full therapeutic effect, and patients should be informed to prevent
premature discontinuation. Sertraline is typically taken in the morning due to potential insomnia (B). Tyramine
restrictions (C) apply to MAOIs, not SSRIs. Routine blood level monitoring (D) is not required for sertraline.
HIGHP - Page 4 of 47
